Youth Tour Recommendation Form

Flint Energies Washington Youth Tour

Recommendation Form
The Once in a Lifetime Experience

Once a year, local high school students are selected by Flint Energies to represent our cooperative and state as delegates on the Washington Youth Tour. This top-notch leadership experience and tour of Washington, D.C. includes meetings with state and national leaders, teambuilding activities, and visits to all the major sites. Participants join over 1,500 other students from around the nation—all expenses paid—for one incredible week in our nation's capital.

Please complete this recommendation form. All information will be kept confidential.
Referee's Full Name*

First NameLast Name
Referee's Email Address*
example@example.com
Referee's Phone Number
Please enter a valid phone number.
Youth Tour Applicant's Full Name*

First NameLast Name
Relationship to Applicant*

TeacherSchool CounselorMentorOther
List three words to best describe the applicant:*
How long and in what capacity have you known the applicant?*
How comfortable do you feel this applicant will be about spending a week away from home with a large group of unfamiliar people? This trip will involve being away for an extended period and interacting with many others, so it's important to assess how they handle new environments and social situations.*
Does the applicant demonstrate the following skills or performance? Please rate them below: (1 = worst, 3 = fair, 5=best)
Leadership*

1

2

3

4

5

1 is Worst, 5 is Best
Communication*

1

2

3

4

5

1 is Worst, 5 is Best
Being proactive*

1

2

3

4

5

1 is Worst, 5 is Best
Responsbility*

1

2

3

4

5

1 is Worst, 5 is Best
Maturity*

1

2

3

4

5

1 is Worst, 5 is Best
Group participation*

1

2

3

4

5

1 is Worst, 5 is Best
Consideration of others*

1

2

3

4

5

1 is Worst, 5 is Best
Punctuality*

1

2

3

4

5

1 is Worst, 5 is Best
Is there anything you would like to share with Flint Energies about the applicant and how this experience would benefit them?
Overall Rating*

ExcellentGoodAverageBelow AveragePoor
Thank you for completing the reference form. If you have any questions, please contact:
Blair Brown
Flint Energies
Youth & Education Specialist
478.218.5547
bbrown@flintemc.com
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Flint Energies Washington Youth Tour

The Once in a Lifetime Experience